Facility Evaluation Report

Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility for the purpose of conducting the required annual inspection. LPA was greeted and granted entry by Administrator (AD) Vladimir Velez and Administrator (AD) Sonia Velez after explaining the purpose for the visit. LPA observed Administrator Vladimir Velez has a valid Administrator certificate which expires on January 9, 2026.

The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents, of which one may be bedridden, and has a hospice waiver for six. The facility is a single story home with four residents bedrooms, one of which is shared, four bathrooms, a break room/staff room, a living room, a dining room, a kitchen, a TV room, a business office, and an attached two car garage. LPA accompanied by the AD, conducted a tour of the interior portion of the facility. On today's visit, LPA observed three residents in care, two of which are on hospice, and two staff present. LPA observed residents relaxing in their respective bedrooms. LPA observed the See Something, Say Something poster (PUB 475) mounted on the wall by the kitchen. LPA inspected the four residents bedrooms which were observed to be free of hazards. LPA observed residents bedrooms to have the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed residents beds to have clean linens and blankets. LPA observed additional linens to be stored in a hallway closet. LPA observed each auditory exit alarm to be operational. LPA inspected the four bathrooms and they were observed to be clean. LPA observed bathrooms to be equipped with grab bars and nonskid floor mats. Faucets and toilets were operational. Hot water temperature measured between 116.2 and 116.6 degrees Fahrenheit.

LPA observed the kitchen has a two day perishable and a seven day nonperishable food supply on hand. LPA observed kitchen appliances to be clean and operational. CONTINUED ON 809-C.